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Can vaginal cancer be prevented?

The best way to reduce the risk of vaginal cancer is to avoid known risk factors and to find and treat any vaginal pre-cancers. But since many women with vaginal cancer have no known risk factors, it is not possible to completely prevent this disease.

Avoid HPV exposure

Infection with human papillomavirus (HPV) is a risk factor for vaginal cancer. HPV infections occur mainly in younger women and are less common in women over 30. The reason for this is not clear.

HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. HPV can be spread during sex – including vaginal intercourse, anal intercourse, and oral sex – but sex doesn’t have to occur for the infection to spread. All that is needed is for there to be skin-to-skin contact with an area of the body infected with HPV. The virus can be spread through genital-to-genital contact. It’s even possible for a genital infection to spread through hand-to-genital contact.

An HPV infection also seems to be able to be spread from one part of the body to another. This means that an infection may start in the cervix and then spread to the vagina and vulva.

It can be very hard to avoid being exposed to HPV. It might be possible to prevent genital HPV infection by not letting others come in contact with your anal or genital area, but even then there could be other ways to become infected that aren’t yet clear. For example, a recent study showed that HPV can be present on sex toys, so sharing sex toys could potentially spread HPV.

Infection with HPV is common, and in most cases the body is able to clear the infection on its own. But in some cases the infection does not go away and becomes chronic. Chronic infection, especially with high-risk HPV types, can eventually cause certain cancers, including vaginal cancer and pre-cancer.

Certain types of sexual behavior increase a woman’s risk of getting a genital HPV infection, such as having sex at an early age and having many sex partners. Although women who have had many sexual partners are more likely to get infected with HPV, a woman who has had only one sexual partner can still get infected. This is more likely if she has a partner who has had many sex partners or if her partner is an uncircumcised male.

Delaying sex until you are older can help you avoid HPV. It also helps if you limit your number of sex partners and avoid having sex with someone who has had many other sex partners.

A person can be infected with HPV for years without any symptoms, so the absence of visible warts cannot be used to tell if someone has HPV. Even when someone doesn’t have warts (or any other symptom), he (or she) can still be infected with HPV and pass the virus to somebody else.

HPV and men

The 2 main factors influencing the risk of genital HPV infection in men are circumcision and the number of sexual partners. Men who are circumcised (have had the foreskin of the penis removed) have a lower chance of becoming and staying infected with HPV.

Men who have not been circumcised are more likely to be infected with HPV and pass it on to their partners. The reasons for this are unclear. It may be that the skin on the glans of the penis goes through changes that make it more resistant to HPV infection. Another theory is that the surface of the foreskin (which is removed by circumcision) is more easily infected by HPV. Still, circumcision does not completely protect against HPV infection – men who are circumcised can still get HPV and pass it on to their partners.

The risk of a man being infected with HPV is also strongly linked to having many sexual partners over a man’s lifetime.

Condoms and HPV

Condoms (“rubbers”) provide some protection against HPV. One study found that when condoms are used correctly every time sex occurs, they can lower the HPV infection rate by about 70%. Condoms cannot protect completely because they don’t cover every possible HPV-infected area of the body, such as skin on the genital or anal area. Still, condoms do provide some protection against HPV, and they also protect against HIV and some other sexually transmitted diseases. Condoms (when used by the male partner) also seem to help genital HPV infections clear (go away) faster in both women and men.

Get vaccinated

Vaccines are available that protect against certain HPV infections. All of them protect against infection with HPV subtypes 16 and 18. Some can also protect against infections with other HPV subtypes, including some types that cause anal and genital warts.

These vaccines can only be used to prevent HPV infection – they do not help treat an existing infection. To be most effective, the vaccines should be given before a person is exposed to HPV (such as through sexual activity).

Some of these vaccines, Gardasil® and Gardasil 9®, are approved to help prevent vaginal cancers and pre-cancers. They are also approved to help prevent others cancers, as well as anal and genital warts.

Cervarix®, another HPV vaccine available in the US, also helps prevent some HPV infections. It is known to help prevent cervical cancers and pre-cancers, but so far hasn’t been shown to help prevent vaginal cancer or pre-cancer

Don’t smoke

Not smoking is another way to lower vaginal cancer risk. Women who don’t smoke are also less likely to develop a number of other cancers, such as those of the lungs, mouth, throat, bladder, kidneys, and several other organs.

Find and treat pre-cancerous conditions

Most vaginal squamous cell cancers are believed to start out as pre-cancerous changes, called vaginal intraepithelial neoplasia or VAIN. VAIN may be present for years before turning into a true (invasive) cancer. Screening for cervical cancer (such as with a Pap test or HPV test) can sometimes pick up these pre-cancers. If a pre-cancer is found, it can be treated, stopping cancer before it really starts.

Still, since vaginal cancer and VAIN are rare, doctors do not often do other tests to look for these conditions in women who do not have symptoms or a history of pre-cancer or cancer of the cervix, vagina, or vulva.

How Pap tests and pelvic examinations are done

First, the skin of the outer vaginal lips (labia majora) and inner lips (labia minora) is examined for any visible abnormalities. The health care professional first places a speculum inside the vagina. A speculum is a metal or plastic instrument that keeps the vagina open so that the cervix can be seen clearly. Next, using a small spatula, a sample of cells and mucus is lightly scraped from the exocervix (the surface of the cervix that is closest to the vagina). A small brush or a cotton-tipped swab is then inserted into the cervical opening to take a sample from the endocervix (the inside part of the cervix that is closest to the body of the uterus).Then, the speculum is removed.

The doctor then checks the organs of the pelvis by inserting 1 or 2 gloved fingers of one hand into the vagina while feeling (palpating) the lower abdomen, just above the pubic bone, with the other. The doctor may do a rectal exam at this time also. It’s very important to know that a Pap test is not always done when a pelvic exam is done, so if you are uncertain you should ask if one was done.

Vaginal intraepithelial neoplasia (VAIN; pre-cancer of the vagina) may not be visible during a routine exam of the vagina. But it may be found with a Pap test. Because cervical cancer is much more common than vaginal cancer, Pap test samples are scraped or brushed from the cervix. However, some cells of the vaginal lining are usually also picked up at the same time. That allows cases of VAIN to be found in women whose vaginal lining is not intentionally scraped. Still, the main goal of a Pap test is to find cervical pre-cancers and early cervical cancers, not vaginal cancer or VAIN. That’s why women who have had a total hysterectomy (removal of the uterus and cervix) stop getting Pap tests, unless the hysterectomy was done as a treatment for cervical pre-cancer (or cancer).

In women whose cervix has been removed by surgery to treat cervical cancer or pre-cancer, Pap test samples may be taken from the lining of the upper vagina to look for cervical cancer (that has come back), and to look for early vaginal cancer or VAIN. Vaginal cancer and VAIN are more common in women who have had cervical cancer or pre-cancer.

Many women with VAIN may also have a pre-cancer of the cervix (known as cervicalintraepithelial neoplasia or CIN). If abnormal cells are seen on a Pap test, the next step is a procedure called colposcopy, in which the cervix, the vagina, and at times the vulva are examined with a special instrument called a colposcope.